CN103997995B - System, interface device, application of interface device and method for eye surgery - Google Patents

Abstract

A laser system for eye surgery, the laser system comprising: an ophthalmic surgical laser apparatus, the laser apparatus having: an optical assembly for providing pulsed focused laser radiation having radiation properties matching the generation of photodisruptions in human eye tissue, and a control unit for positional control of the radiation focus of the laser radiation, the control unit being designed for executing a plurality of control programs representing a plurality of types of incision shapes; and a set of interface devices, each interface device comprising: a laser radiation transparent contact body having an abutment face for abutment against an eye to be treated, and a coupling portion for detachably coupling the interface device on a counter-coupling portion of the laser apparatus, each interface device of the set of interface devices differing by a different optical effect of the laser radiation provided to the laser apparatus.

Description

System for eye surgery, interface device, application of interface device and method

technical field

In general, the present invention relates to laser surgical treatment of the human eye. More specifically, the present invention relates to various forms of application to the treatment of the human eye with the aid of one or the same eye surgical laser device.

Background technique

The use of focused pulsed radiation for the purpose of creating incisions in the corneal tissue or other tissue sites of the human eye has been the subject of intense research in human ophthalmology for some time. Instruments that provide this type of laser radiation to produce incisions have also been placed on the market. In general, ultrashort-pulse laser radiation with pulse widths in the femtosecond range came into use in this respect. However, the invention is not limited thereto, but also encompasses the ability to produce incisions in keratitis tissue using laser radiation having shorter and much longer pulse widths, e.g., pulse widths in the attosecond range, or in the 1, 2 or 3 digits in the picosecond range.

The physical effect used in the process of making incisions with pulsed laser radiation is known as laser-induced light penetration, which results in so-called photodisruption, the level of which is limited roughly to the focus of the radiation at the waist point of the radiation Degree. Due to the juxtaposition of a large number of such photodisruptions, different and relatively complex incision shapes are produced in the ocular tissue.

An exemplary application of producing an incision by means of pulsed laser radiation is known as LASIK (Laser In Situ Keratomileusis). In this surgical procedure which is generally classified as refractive surgery, that is, surgery aimed at eliminating or at least improving the defective imaging properties of the eye - first a transverse incision of the human cornea (from a recumbent patient point of view), resulting in a small cover (often called a flap in the professional world) that can be folded over to one side. After the flap has been folded, the stroma of the cornea is exposed, in this case a so-called resection is carried out by means of laser radiation (for example, excimer radiation with a wavelength of 193 nm), ie according to the suitable The cutting profile examines the interstitial tissue. Thereafter, the small cover (flap) is folded back, at which point a relatively painless and rapid healing process takes place. After this intervention, the cornea has different imaging properties, in which respect a substantially complete elimination of the previous visual impairment is best achieved.

As an alternative to the existing "classical" procedure (mechanical microkeratome), cutting of the skin flap can also be performed using laser technology. The current concept of this technique generally provides that the anterior surface of the cornea is flattened (flattened) by abutting the planar abutment of a contact element transparent to laser radiation, and then the flap is passed through a bedincision at a constant depth. and a transverse incision extending from the underlying incision to the surface of the cornea. The flattening of the cornea allows the underlying incision to be two-dimensional, such that only the position of the radiation focus in a plane (designated in traditional notation as the x-y plane) perpendicular to the direction of propagation of the radiation needs to be controlled, but not along the propagation of the laser radiation direction (according to conventional notation, this direction is designated as the z-direction) where radiation is focused. For example, as described in EP1837696 by the applicant, with the aid of a liquid lens, control over the position of the radiation focus in the z-direction can be achieved. In this respect, reference is made to the aforementioned patent application, the content of which is incorporated into the present application. In summary, the control of the radiation focus position is described in EP2111831 and WO2010/142311 of the applicant, the contents of which are incorporated in the present application.

Another form of procedure is laser-assisted lenticular keratectomy, in which an incision is made in the cornea by means of pulsed laser radiation. In this case, in the stroma of the cornea, in which, for example, tissue volumes have the shape of small discs, are freely severed by means of auxiliary incisions that can be excised from the eye. Depending on the indication (eg myopia, hyperopia), the lens body to be removed may have different shapes. For the purpose of freely cutting the lens body, the process has so far generally been carried out by first forming in the cornea a lower incision surface that bounds the lower side of the lens body (the back side of the lens body), and a lower cut surface that bounds the upper side of the lens body (the rear side of the lens body). The upper incision surface of the front side), both of which are often three-dimensional, require z-direction control of the radiation focus.

An x-y-adjustment of the radiation focus in the cornea can be performed with a sufficiently fast scanner, for example with a current-controlled scanning mirror. On the other hand, available z-scanners (that is, scanners capable of focus shifting in the z-direction) - are generally relatively slow compared to galvano-mirror scanners. Furthermore, only a limited z-range can be covered with available z-scanners.

In contrast, in the aforementioned eye refractive surgery based on LASIK and on the basis of lenticular keratectomy, an incision is made in the cornea, and in the case of cataract surgery, the incision is made on the lens of the human eye. However, mere z-shifting of the laser focus of the laser beam by means of a laser device with the aid of a z-scanner does not allow the focus to reach deeper in the eye with a sufficiently good quality, so that the lens (in the eye Cuts in deeper locations) have the same quality as cuts on the cornea.

It is therefore an object of the present invention to provide a laser system with a laser device for eye surgery, the laser device, and a set of interface devices for the laser device for eye surgery, by means of which it is possible to operate in the same eye surgery Various types of treatments are performed with laser devices. Furthermore, it is an object of the present invention to provide a suitable method of laser surgical eye treatment for various forms of treatment with the aid of the eye surgical laser device.

Contents of the invention

This object is achieved by the subject-matter of the independent claims. Advantageous embodiments are shown in the dependent claims.

In the following, although the terms "interface device", "interface unit", "patient interface", "patient adapter" and "eye interface" are used interchangeably, they should be understood as synonymous.

According to a first aspect of the invention, a laser system for eye surgery according to the invention comprises an eye surgery laser device and a set of interface devices (patient/eye interface). An eye surgery laser device comprising: an optical assembly for providing pulsed focused laser radiation having radiation properties matched to the generation of photodisruption in human eye tissue; and a radiation for said laser radiation Control unit for position control of the focus (radiation focus). The control unit is designed to execute a plurality of control programs representing various types of incision shapes. Each interface device in the set of interface devices comprises: a contact body transparent to the laser radiation, the contact body having an abutment surface for abutting against the eye to be treated; and a coupling portion, the coupling Part is used to detachably couple the interface device (patient interface) to the counter-coupling portion of the laser device; each interface device of this group is due to the Different optical effects of laser radiation, eg for laser radiation emitted from a laser device, differ.

It is possible that at least a subgroup of the interface means differs due to different influences on the position of the radiation focus relative to the abutment surface.

For example, different optical effects may include the fact that, depending on the coupling of an interface device to the coupling part, in the case of the same laser device, the focal point of the laser radiation may be positioned at different positions in the eye relative to the abutment surface (i.e. at different focus positions). For example, depending on the coupled interface device, the focal position (the location of the focal point) may be located in the cornea of the eye, in the lens of the eye, or at various points on or in the eye, such as in the iridocorneal angle of the eye. For example, in the case of a coupling of the first interface device between 250 μm and 350 μm, in particular between 280 μm and 320 μm and preferably at 300 μm, a focal position (i.e. focal point in the z-direction relative to the abutment surface) can be envisaged is located how deep in the eye). Such an interface device would be suitable for operational application for the purpose of machining the cornea with the aid of a laser device for ophthalmic surgery. Also, for example, in the case of a coupling of the second interface device at 4 mm and 6 mm, especially at 4.5 mm and 5.5 mm and preferably at 5 mm, it is conceivable that the focal position is below the contact lens of the interface device. Such an interface device would be suitable for operational application for the purpose of machining a lens with the aid of a laser device for ophthalmic surgery.

The different optical effects may further include the fact that, depending on the coupled interface device, different ranges of adjustment in the z-direction (i.e. different ranges of depth of focus) are possible, or depending on the uniform laser device setting in the z-direction Different ranges of adjustments. For example, depending on the coupled interface device, the depth-of-focus range (i.e., the adjustment range of focus in the z-direction) can be matched, or can be matched to the machining of the cornea of the eye, or to the lens of the eye or to the or on other points within the eye. For example, where the coupling of the first interface device is between 1 mm and 1.4 mm, especially between 1.1 mm and 1.3 mm and preferably at 1.2 mm, a depth range of focus (i.e. how far the focus can be adjusted along the z-direction of the same laser device with the aid of the instrument). Such an interface device would be suitable for operational application for the purpose of machining the cornea with the aid of a laser device for ophthalmic surgery. Likewise, in the case of a coupling of the second interface device between 8 mm and 16 mm, in particular between 10 mm and 14 mm and preferably at 12 mm, a depth range of focus can be envisaged. This is especially true when it comes to focusing. Such an interface device would be suitable for operational application for the purpose of machining a lens with the aid of a laser device for ophthalmic surgery. A value for the depth of focus required for the respective application can be set, for example via the z-scanner and the patient interface.

The different optical effects may further include the fact that, depending on the coupled interface device, focal points of different spot diameters are obtained in the same laser device. For example, depending on the coupled interface device, the spot diameter of the focal point may be matched to the machining of the cornea of the eye, the lens of the eye, or other points on or in the eye. For example, spot diameters are conceivable in the case of a coupling of the first interface device between 1 μm and 6 μm, in particular between 2 μm and 5 μm, preferably between 3 μm and 5 μm. Such an interface device would be suitable for operational application for the purpose of machining the cornea with the aid of a laser device for ophthalmic surgery. Likewise, spot diameters are conceivable in the case of a coupling of the second interface device between 3 μm and 14 μm, in particular between 4 μm and 12 μm, preferably between 5 μm and 10 μm. Such an interface device would be suitable for operational application for the purpose of machining a lens with the aid of a laser device for ophthalmic surgery.

The different optical effects may further include the fact that, depending on the coupled interface device, different scan field diameters (i.e. different diameters of the area that can be illuminated by the laser beam in the x-y direction/plane) are obtained in the same laser device. For example, depending on the coupled interface device, the scan field diameter may be matched to the machining of the cornea of the eye, the lens of the eye, or other points on or in the eye. For example, a scanning field diameter is conceivable in the case of a coupling of the first interface device between 9 mm and 15 mm, in particular between 11 mm and 13 mm, preferably 12 mm. Such an interface device would be suitable for operational application for the purpose of machining the cornea with the aid of a laser device for ophthalmic surgery. Likewise, a scanning field diameter can be envisaged in the case of a coupling of the second interface device between 5 mm and 9 mm, in particular between 6 mm and 8 mm, preferably 7 mm. Such an interface device would be suitable for operational application for the purpose of machining a lens with the aid of a laser device for ophthalmic surgery.

Preferably, the different optical effects of the laser radiation provided in the laser device have the result that there is a small and at least almost equally large (homogeneous) focus in the machined region within the eye. In particular, this leads to a good suitable focus in the laser radiation with low pulse energy and/or in the light load of the patient.

Furthermore, at least one subset of the interface device may differ due to a different shape/position of at least one optical boundary surface. For example, the optical boundary surface may be, for example, a face of a contact lens present in a corresponding interface device, which normally provides an abutment with the eye. It is also possible that, in addition to the contact lens, the surfaces of the optical auxiliary elements present in the contact device form the optical boundary surface. It is therefore also conceivable that at least one subgroup of the interface device differs due to a different number of optical elements. For example, these optical elements may comprise contact lenses for use against the eye or optical auxiliary elements such as lenses (refractive optical elements) or diffractive optical elements.

At least one of the interface devices may comprise an applanation cone designed for coupling to the eye and to the focusing optics of the laser device. However, several, a large number or all of the interface devices may include this type of applanation cone.

The laser device may further comprise an adaptive optics element arranged upstream of the focusing optics of the laser device in the direction of propagation of the laser radiation. The adaptive optical elements may comprise adaptive mirrors or light transmission adaptive systems. In this case, the adaptive optical element may provide a compensation for possible increased wavefront aberrations. This increase may occur, for example, if the laser system is used in a different application. In particular, focusing at depths that require an extended range must be corrected during cutting of the lens.

At least one of said interface devices may comprise a code/code enabling the laser device to execute a control program in the control unit according to said code/code. For example, the laser device may preferably automatically recognize said code/code and invoke an associated control program (assigned to said code/code) in said control unit.

According to a second aspect of the present invention, a set of interface devices is available for an eye surgery laser device, eg an interface device (patient interface) for each instance of application in a respective eye. Each interface device comprises a contact body permeable to the laser radiation of the laser device, the contact body having an abutment surface for abutting against the eye to be treated; and a coupling portion for attaching the interface device detachably coupled to the coupling portion of the laser device. The interface device: (i) differs due to a different influence on the radiation focus of said laser radiation relative to the position of said abutment surface, and/or (ii) said interface device differs due to a different shape of at least one optical boundary surface and and/or positionally, and/or (iii) the interface device differs due to a different number of optical elements, resulting in laser radiation with different optical effects in the laser device (e.g. resulting in differently focused beams, deflected beams and / or split beams). In particular, depending on which interface device is connected to the laser device, different machining regions in the x-y-direction and/or z-direction (eg focused depth ranges) can be covered by means of the interface device.

At least one or a subset of the interface devices may comprise planar contact lenses. In the case of such planar contact lenses, the face adapted to abut against the eye takes the form of a planar abutment face, the face located opposite to said abutment face (the face facing away from the eye) being designed to be in contact with said abutment face. The junctions form parallel faces. At least one of the interface devices may comprise an optical auxiliary element. For example, the optical auxiliary element can be present in the interface device or in an interface device with a planar contact lens. For example, the optical auxiliary element can be arranged in the interface device in such a way that the face facing away from the contact lens is shaped convexly or planarly and the face facing the contact lens is shaped concavely. However, other designs of the optical auxiliary element are also conceivable. Irrespective of the exact shape of the optical auxiliary element, the face facing the contact lens and/or the face of the optical auxiliary element facing away from the contact lens can be formed as an optically free-form surface.

At least one or a subset of the interface devices comprise biconcave contact lenses. In the case of biconcave contact lenses of this type, a concave abutment surface is provided for abutting against the eye, the surface located opposite the abutment surface being concavely formed. Additionally or alternatively, at least one of the interface devices may comprise a meniscus contact lens or a plano-concave contact lens. In the case of a meniscus contact lens, a concave abutment surface is provided for abutment against the eye, the surface located opposite the abutment surface being convexly shaped. In the case of a plano-concave contact lens, a concave abutment surface is provided for abutment against the eye, the surface located opposite the abutment surface being shaped in planar form. Irrespective of the exact configuration of the contact lens, the abutment surface and/or the surface located opposite the abutment surface may take the form of an optically free-form surface with refractive or diffractive effects.

According to a third aspect of the invention there is provided a set of applications of interface devices, said applications comprising a variable operational application of one of said interface devices in each case in an eye surgery laser device. The laser device comprises: an optical assembly for obtaining pulsed focused laser radiation having radiation properties matched to the generation of photodisruption in human eye tissue; and a radiation focusing device for said laser radiation Control unit for position control. The control unit is designed to execute a plurality of control programs representing various types of incision shapes, each interface device comprising a contact body transparent to the laser radiation having a an abutment surface of the eye; and a coupling portion for detachably coupling the interface device to a counter-coupling portion of the laser device. The interface devices of the set differ due to different optical effects on said laser radiation provided in said laser radiation, for example on laser radiation emanating from a laser device; and the application includes each of said set of interface devices The interface device is operable according to the application of the control program to be executed in a given situation.

At least a subset of the interface devices may differ due to different effects on the location of the radiation focus relative to the abutment surface. Furthermore, at least one subset of the interface devices may differ due to different shapes and/or different positions of the optical boundary surfaces. It is also conceivable that at least a subgroup of the interface means differs due to a different number of optical elements.

In the event of an exchange of the interface device, the focus setting of the focusing optics of the laser device can remain unchanged. Thus, different optical effects in the laser device are achieved in the same laser device due to the exchange of the interface device for the respective application and the focus setting remaining unchanged.

In the case of an exchange of the interface device, the control unit can control the laser device in such a way that an adaptive optics element or a light transmission adaptive system is introduced or driven into the beam path of the laser radiation. For this purpose, there may be a corresponding code/code for the interface device, on the basis of which the identification of the interface device takes place. Then, based on the above identification, the associated adaptive element or system (assigned to the above code/code) can be introduced, for example automatically, into the beam path. The adaptive optics or light projection adaptive system is also introduced upstream of the focusing optics of the laser device in the direction of propagation of the laser radiation.

According to a fourth aspect of the present invention there is provided a method for laser surgical eye treatment wherein pulsed focused laser radiation having radiation properties matched to the generation of photodisruption of human eye tissue is provided by means of a laser device , and the position of the radiation focus of the laser radiation is controlled by means of a control unit; wherein, in the case of a first treatment type, a sequence of at least one control program representing the shape of an incision of the first type is carried out by means of said control unit, whereby A first interface device matched to the first treatment type is placed over the laser radiation transparent contact body, the contact body has an abutment surface against the eye to be treated, and the first interface The device is detachably coupled to a counter-coupling part of said laser device via a coupling part; wherein, in the case of a second treatment type, at least A sequence of control programs is carried out by means of the control unit such that a second interface device adapted to the second type of treatment is placed on the laser radiation permeable contact body having against the abutment surface of the eye to be treated, and the second interface device is detachably coupled to the counter-coupling part of the laser device via the coupling part.

For example, the code/code in the aforementioned interface device can be used to ensure that the associated control program is automatically identified, set up and executed.

The first type of treatment may include the treatment of the cornea of the eye by means of the laser radiation. The second type of treatment comprises the treatment of the lens of the eye by means of the laser radiation.

In an alternative embodiment, it is conceivable that the second type of treatment comprises treatment of areas of the iris, retina, vitreous or iridocorneal angle (eg for the purpose of treating glaucoma) by means of laser emission.

In the case of a third treatment type, a sequence of at least one control program representing a third type of incision shape different from the first type of incision shape and/or the second type of incision shape can be controlled by means of the control unit performed such that a third interface device matching said third treatment type is placed over said laser radiation permeable contact body having an abutment surface against the eye to be treated, and A third interface device is detachably coupled on the counter-coupling part of the laser device via a coupling part, and the third treatment type may comprise treatment of the iris of the eye by means of the laser radiation.

In the case of a fourth treatment type, a sequence of at least one control program representing a fourth type of incision shape different from said first type of incision shape, second type of incision shape and/or third type of incision shape By means of the control unit it can be executed such that a fourth interface device matched to the fourth treatment type is placed on the laser radiation permeable contact body having a The abutment surface of the eye, and the fourth interface device is detachably coupled to the coupling part of the laser device via the coupling part, and the fourth treatment type may include the iridocorneal angle of the eye by means of the laser radiation Glaucoma treatment.

In the case of a fifth treatment type, representing a fifth type of incision shape different from said first type of incision shape, second type of incision shape, third type of incision shape and/or fourth type of incision shape A sequence of at least one control program can be executed by means of said control unit, whereby a fifth interface device matching said fifth treatment type is placed on said laser radiation permeable contact body, said contact The main body has an abutment surface against the eye to be treated, and a fifth interface device is detachably coupled to the counter-coupling part of the laser device via a coupling part, and the fifth treatment type may include radiation by means of the laser Treatment of the vitreous of the eye.

In the case of a sixth treatment type, representing an incision shape different from said first type, second type of incision shape, third type of incision shape, fourth type of incision shape and/or fifth type of incision shape A sequence of at least one control program for a sixth type of incision shape can be executed by means of said control unit, whereby a sixth interface device matching said sixth treatment type is placed in said laser radiation permeable contact On the main body, the contact main body has an abutment surface against the eye to be treated, and a sixth interface device is detachably coupled to the counter-coupling part of the laser device via a coupling part, and the sixth treatment type Treatment of the retina of the eye by means of said laser radiation may be included.

Description of drawings

Hereinafter, the present invention will be further explained based on schematic drawings. in:

Figure 1 is a schematic block diagram of elements of a laser device for eye surgical treatment according to one embodiment;

Figure 2a is a schematic diagram of the beam path of a laser beam for machining the cornea of a human eye;

Figure 2b is a schematic diagram of the beam path of a laser beam for machining the lens of the human eye;

Figure 2c is a schematic diagram of the beam path of a laser beam for machining the iris of the human eye;

Figure 2d is a schematic diagram of the beam path of a laser beam for machining the iridocorneal angle of the human eye;

Figure 2e is a schematic diagram of the beam path of a laser beam for machining the vitreous of the human eye;

Figure 2f is a schematic diagram of the beam path of a laser beam for machining the retina of a human eye;

Figure 3 is another schematic diagram of the beam path of the laser beam for the lens of Figure 2b;

Figure 4a is a schematic diagram of a first interface device used in the laser device according to Figure 1;

Figure 4b is a schematic diagram of a second interface device used in the laser device according to Figure 1;

Figure 4c is a schematic diagram of a third interface device used in the laser device according to Figure 1;

Figure 4d is a schematic diagram of a fourth interface device used in the laser device according to Figure 1;

Figure 4e is a schematic diagram of a fifth interface device used in the laser device according to Figure 1; and

Fig. 4f is a schematic diagram of a sixth interface device used in the laser device according to Fig. 1 .

detailed description

The laser device shown in FIG. 1 (indicated generally by 10 therein) comprises a laser source 12 for providing a pulsed laser beam 14, in this case wherein the pulse width of the radiation pulse is suitable for the laser beam 14 to be The corneal tissue of the patient's eye 16 is treated for the purpose of making an incision. For example, the pulse width of the radiation pulses of the laser beam 14 is in the nanosecond, picosecond, femtosecond or attosecond range. The laser beam 14 obtained by the laser source 12 has a pulse repetition rate required in the proposed application, that is, the repetition rate of the radiation pulse emitted from the laser device 10 and directed to the eye 16 corresponds to that obtained at the output of the laser source 12 to the repetition rate of the radiation pulses; unless part of the number of radiation pulses emitted from the laser source 12 is blocked by means of an optical switch 18 arranged in the radiation path of the laser beam 14 in a manner according to a predetermined mechanically processed contour of the eye 16 . Such blocked radiation pulses accordingly do not reach the eye 16 .

In a manner not shown in detail but known, for example the laser source 12 may comprise: a laser oscillator (eg a solid-state laser oscillator); a preamplifier which increases the pulse power of the laser pulses emitted by the oscillator, and Simultaneously stretching them in time; a subsequent pulse picker, which selects individual laser pulses from the pre-amplified laser pulses of the oscillator, in such a way that the repetition rate is reduced to the desired level; the power an amplifier, which amplifies the selected simultaneously temporally stretched pulses to a pulse energy as described in the application; and a pulse compressor, which compresses the pulse output from the power amplifier in time to the desired of the pulse width.

The optical switch 18 , which can also be designed as a pulse modulator, can for example take the form of an acousto-optic modulator or an electro-optic modulator. In general, optical switch 18 may comprise any optically active element capable of rapidly blocking individual laser pulses. The optical switch 18 may for example comprise a beam trap, schematically indicated at 20 , for absorbing the radiation pulse to be blocked, which part of the radiation pulse does not reach the eye 16 . The optical switch 18 is capable of deflecting the radiation pulse to be blocked from the normal beam path of the radiation pulse of the laser beam 14 and directing it onto the beam trap 20 .

In the beam path of the laser beam 14 further optical components are arranged, comprising, in the exemplary case shown, a z-scanner 22 ; an x-y scanner 24 ; and a focusing objective 26 . Focusing objective 26 is used to focus laser beam 14 on a desired machining location on or within eye 16, in particular a location in the cornea of the eye. The z-scanner 22 is used to longitudinally control the position of the focal point of the laser beam 14; on the other hand, the x-y scanner 24 is used to laterally control the position of the focal point. In this respect, "longitudinal" refers to the direction of propagation of the laser beam 14; it is denoted in conventional notation as the z-direction. "Transverse" on the other hand refers to the direction perpendicular to the propagation of the laser beam 14; it is denoted in conventional notation as the x-y plane. For purposes of illustration, a coordinate system representing the x-y-z directions in the region of the eye 16 is shown in FIG. 1 .

For the purpose of lateral deflection of the laser beam 14, the x-y scanner 24 may, for example, comprise current-controlled driven scanning mirrors capable of tilting about mutually perpendicular axes. On the other hand, the divergence of the laser beam 14 and thus the beam 14 can be influenced by means of the z-scanner 22 , which can for example comprise a longitudinally adjustable lens or a variable refractive power lens or a deformable mirror. The z-position of the focus. For example, such an adjustable lens or mirror can be included in a beam amplifier (not shown in detail) and it amplifies the laser beam 14 emitted from the laser source 12 . The beam amplifier can be configured as a Galilean telescope, for example.

Focusing objective 26 is preferably an f-theta objective and is detachably coupled, preferably on its beam-exit side, to patient adapter 28a , wherein patient adapter 28a constitutes an abutment interface for the cornea of eye 16 . For this purpose, the patient adapter 28 a comprises a laser-radiation-transmissive contact element 30 a , which on its lower side facing the eye comprises an abutment surface 32 a for the cornea of the eye 16 . In the exemplary case shown, this abutment surface 32a is realized in the form of a planar surface and serves to applanate the cornea by pressing the contact element 30a against the eye 16 with suitable pressure, or by negative pressure. Its cornea 16a is sucked into the abutment surface 32a. The contact element 30a, which in the case of a plane-parallel design is usually designated as a flat plate, is mounted to the narrower end of a conically enlarged carrier sleeve 34a. The connection between the contact element 30a and the carrier sleeve 34a can be permanent, for example by means of adhesive bonding, or the connection between the contact element 30a and the carrier sleeve 34a can be detachable, for example by means of a screw coupling . Furthermore, it is conceivable to use an optically injection-molded part which has the function of the carrier sleeve 34a and of the contact element 30a. In a manner not shown in detail, the carrier sleeve 34 a has suitable coupling structures at its wider sleeve end (upper end in the figure) for coupling to the focusing substance 26 .

It will be appreciated that the order of optical switch 18 , z-scanner 22 , x-y scanner 24 and focusing objective 26 is not necessarily as shown in FIG. 1 . For example, the optical switch 18 could easily be arranged downstream of the beam path of the z-scanner 22 . As such, the order in which these components are shown in FIG. 1 should not be construed as limiting.

The laser source 12, the optical switch 18 and the two scanners 22, 24 (these two scanners are also combined in one structural unit if desired) are controlled by a control computer 36 according to the control stored in the memory 38. Program 40 to run. The control program 40 contains instructions (program code) executed by the control computer 36 to obtain the volume of corneal tissue to be removed in the context of lenticular keratectomy or keratoplasty, such control including directing the laser beam 14 The location of the focus of the light beam is controlled in the cornea of the eye 16 against the contact element 30a, in the lens, or elsewhere; and, for example, in the process of machining the cornea, creating an incision shape that is completely separated from the surrounding corneal tissue. If desired, the shape of the incision can additionally result in a division of the tissue volume into a plurality of mutually isolated volume segments.

Furthermore, an adaptive optics element or an adaptive optics system in the exemplary manner employing a mirror 42 can be introduced into the radiation path of the laser beam 14 upstream of the focusing objective 26 . The mirror 42 can be designed as a deformable mirror. Furthermore, another adaptive optical element or light projection adaptive system may be provided instead of the mirror 42 . If the lens of the eye 16 is machined to reduce wavefront aberrations, a mirror 42 is preferably introduced into the radiation path of the laser beam 14 . During the machining of the cornea of the eye 16, the mirror 42 can be placed in a zero position (rest position) using a radiation path shown in dashed lines in FIG. 1 in which the laser beam 14 does not pass through the through mirror 42 (mirror 42 does not affect laser beam 14). Control of the radiation path (eg, whether mirror 42 is introduced into the radiation path or not) may be effected by control computer 36 . In an alternative embodiment, the mirror remains in the beam path so that actuation is achieved via activation of the application, depending on the application.

In the case of the laser device 10 shown in FIG. 1 , a patient adapter (interface unit) 28 a is coupled in the focusing objective 26 in exemplary manner. The eye 16 in FIG. 1 is thus abutted against the flat abutment surface 32a of the contact element 30a associated with the patient adapter 28a. The patient adapter 28a is shown in more detail in Figure 4a. Patient adapters 28b to 28e shown in FIGS. 4b to 4e are combined with patient adapter 28a of FIG. 4a to form a set of patient adapters, all of which are preferably capable of coupling with the same focusing objective 26 . Further patient adapters 28b to 28e will be described in more detail with reference to Figures 4b to 4e. Firstly, however, it has generally been established what influence different patient adapters have on the optical performance of the laser device 10 .

In Figures 2a to 2f six different types of patient adapters 28u, 28v, 28w, 28x, 28y, 28z are shown. The patient adapter 28u comprises a contact lens 30u having an abutment surface 32u for abutting against the eye 16 and enabling machining of the cornea 16a of the eye 16 with the aid of the laser beam 14 . On the other hand, the patient adapter 28v includes a contact lens 30v having an abutment surface 32v for abutting against the eye 16 and enabling the cornea 16b of the eye 16 to be repaired without changing the settings of the laser device 10. Machining. Thus, with the same laser device 10 (eg with laser devices having the same setup), a change in the optical effect of the laser device 10 can be obtained. In addition, patient adapter 28w is capable of machining iris 16c of eye 16 with the aid of laser beam 14; patient adapter 28x is capable of machining iridocorneal angle 16e of eye 16 with the aid of laser beam 14; patient adapter 28y is capable of machining The machining of the vitreous body e of the eye 16 is performed with the aid of the laser beam 14 ; the patient adapter 28 z enables the machining of the retina 16 f of the eye 16 with the aid of the laser beam 14 . Patient adapter 28w includes a contact lens 30w having an abutment surface 32w for abutting against eye 16; patient adapter 28x includes a contact lens 30x having an abutment surface 32x for abutting against eye 16; Patient adapter 28y includes a contact lens 30y having an abutment surface 32y for abutting against eye 16; and patient adapter 28z includes a contact lens 30z having an abutment surface 32z for abutting against eye 16 .

The optical effect of the laser device 10 is different due to the fact that the laser beam 14 is focused on the cornea 16 with the patient adapter 28u. This means in particular that the focal point of the laser beam 14 is positioned in the cornea. For the machining of the cornea 16a of a conventional eye, it is advantageous to obtain a focus position Z ₀ of a value of about 110 μm (the focal point and the patient adapter 28u for abutting against the eye 16 in the defined state of the z-scanner 22 distance between the abutment surfaces 32u). Furthermore, for the mechanical processing of the cornea, a variable setting of the focal depth of Δz=0...1200 μm is generally required, that is to say an adjustment range of the focal point of 1.2 mm. In addition, generally, a focal spot diameter of about 3 to 5 μm and a scanning area diameter Φ _F of about 12 mm are required. These properties are satisfied, for example, by the patient adapter 28u.

If the setup of the laser device 10 is maintained, and only the patient adapter 28u is replaced with the patient adapter 28v, the focal point of the laser beam 14 will not be in the cornea 16a, but in the lens 16b of the eye 16 (e.g., the mean focal position Z ₀ takes 5mm value). This is achieved due to the shorter length L2 of patient adapter 28v compared to the length L1 _of patient adapter _28u . Furthermore, due to the patient adapter 28v it is ensured (for example a depth of focus setting of Δz=3 . Thus, although the same laser device 10 is used, machining of the lens 16b of the eye can be performed.

The above remarks are applicable to the application of other patient adapters 28w, 28x, 28y, 28z. Furthermore, when one of these patient adapters 28w, 28x, 28y, 28z is connected to the same laser device 10, for example, through the possibility of different settings of the depth of focus, and the presence of different spot diameters and different scanning areas diameter, to obtain different machined areas. A summary of typical values for these examples is shown at the end of the specification.

The importance of the above parameters will now be further described based on FIG. 3 .

In FIG. 3 , the focus position z ₀ of the laser beam 14 can be up to about 0.8 mm in the exemplary embodiment. Focus position z ₀ specifies, for the defined state of z-scanning, how deeply the focus is positioned in the eye in the z-direction (here, with respect to the front surface of the lens 16b; with respect to the abutment surface 32y, in the example In the permanent mode, the focus position z ₀ reaches about 4mm). According to FIG. 3 , the depth range Δz of the focus of the laser beam amounts to approximately 4 mm in an exemplary manner and specifies the adjustment range of the focus in the z-direction of the same laser device 10 . By way of example, the scan area diameter Φ _F of about 8 mm specifies the diameter of the area that can be irradiated by the laser beam 14 (with the same laser device 10 ) in the xy direction. It can be seen from FIG. 3 that a larger scanning field diameter Φ _F is required for the machining of the cornea 16 a than for the machining of the lens 16 b. On the other hand, for the machining of the lens 16 , a higher value of the mean focus position z ₀ relative to the abutment surface 32y and a larger adjustment range Δz are required than for the machining of the cornea. However, these values stated in the exemplary manner should not be construed as limiting, but are for illustration only.

4a , 4b , 4c , 4d and 4e illustrate various patient adapters 28a , 28b , 28c , 28d and 28e for the laser device 10 . Depending on the patient adapters 28a, 28b, 28c, 28d and 28e used, different optical effects can be brought about in the laser device 10 . The patient adapter 28 a shown in FIG. 4 a is suitable for carrying out a treatment of the cornea 16 a of the eye 16 , for example making an incision in the cornea 16 a by means of the laser device 10 .

As shown in FIG. 1 , patient adapter 28 a is detachably coupled to focusing objective 26 and forms an abutment interface for cornea 16 a of eye 16 . For this purpose, the patient adapter 28a includes a contact element 30a transparent to laser radiation and, on its underside facing the eye, an abutment surface 32a for the cornea 16a. In the case of the patient adapter 28a, the abutment surface 32a is realized in the form of a flat surface and is used to applanate the cornea by pressing the contact element 30a to the eye 16 with suitable pressure, or to flatten the cornea 16a by negative pressure. is sucked into the contact surface 32a. In the case of the plane-parallel design shown in FIG. 4 , the contact element is generally designed as a flat plate and is mounted to the narrower end of the conically enlarged carrier sleeve 34 a. The connection between the contact element 30a and the carrier sleeve 34a can be permanent, for example by means of adhesive bonding, or the connection between the contact element 30a and the carrier sleeve 34a can be detachable, for example by means of a screw coupling . Alternatively, use injection-molded parts made in one piece in your application. In a manner not shown in detail, the carrier sleeve 34 a has suitable coupling structures at its wider sleeve end for coupling to the focusing substance 26 .

The laser beam 14 shown schematically in FIG. 4a penetrates the main body of the laser-emitting transparent patient adapter 28a and impinges on the planar contact lens 30a. Both faces of the planar contact lens 30a (the abutment face 32a facing the eye 16 and the face 33a facing away from the eye) are shaped flat. The eye 16 to be treated rests against the abutment surface 32a of the contact lens 30a. After passing through the contact lens 30a, the laser beam 14 strikes the cornea 16a at the schematically indicated focus. An incision can be made in the cornea 16a by means of an x-y displacement and a z-displacement of the focal point, according to the type of incision data predetermined by the control program.

Reference numerals in FIGS. 4b to 4e corresponding to reference numerals in FIG. 4a also denote corresponding elements.

FIG. 4 b shows a patient adapter 28 b suitable for machining in the lens 16 b of the eye 16 and capable of coupling with the focusing objective 16 . Just like the patient adapter 28a in FIG. 4a, the patient adapter 28b according to FIG. 4b includes a planar contact lens 30b. Patient adapter 28b includes a shorter length L2 _than patient adapter 28a (having length L1 ₎ . This means that the patient adapter 28b according to FIG. 4b suitable for treating the lens 16b is shortened in the z-direction compared to the patient adapter 28a according to FIG. 4a suitable for treating the cornea 16a. As can be seen in Figure 4b, this shortening causes the focal point of the laser beam 14 to be positioned not in the cornea 16a but in the lens 16b. With the aid of the xy and z-displacement of the focal point, an incision can now be made in the lens 16b. If the laser beam 14 is deflected laterally, based on the further laser beam 14b in Fig. 4b, this results in a lateral displacement of the focal point in the lens 16b. It is schematically shown in Fig. 4b that the focal point has different focal diameters depending on the focal position in the xy-direction and in the z-direction. It can be seen from FIG. 4 b that the focal diameter increases from the focal point of the central laser beam 14 in the transverse direction and in the axial direction. By increasing the laser pulse energy, non-uniform focusing of the different depth regions and lateral beam deflection can be compensated in order to obtain the desired photodisruption threshold in the peripheral region of the lens 16b. Alternatively, however, non-uniform focusing can also be compensated by adaptive optics, diffractive optics or elements with freeform shapes.

FIG. 4c shows a patient adapter 28c suitable for use with the therapeutic lens 16b and capable of being coupled with the focusing objective 16 . In contrast to the patient adapter 28b according to FIG. 4b which uses a planar contact lens 30b, the patient adapter 28c according to FIG. 4c utilizes a concave-convex contact lens 30c. In the case of this meniscus contact lens 30c, the face 33c facing away from the eye 16 is convexly shaped, while the abutment face 32c facing the eye 16 (face against the eye) is concavely shaped. Owing to the concave shape of the abutment surface 32c facing the eye, the increase in intraocular pressure is reduced. The shape of the contact lens 30c is such that the variation in focal diameter produced by the case of the patient adapter 28b of Figure 4b is compensated at the focal point. It can be seen in Fig. 4c that the central foci (compared to Fig. 4b) are either preserved (they remain unchanged) or slightly enlarged (deteriorated), and the focal diameters of the foci in the peripheral regions (compared to Fig. 4b) are in Reduction (improvement) both laterally and axially. Thus, regardless of the position of the focal point in the transverse and axial directions, the focal diameter of the focal point comprises at least a nearly constant focal diameter. This at least nearly constant focal diameter can be obtained, for example, by freeform surfaces formed on the contact lens 30c. For example, the abutment face facing the eye and/or the face 33c of the contact lens 30c facing away from the eye may be formed as free-form surfaces. Thus, in the edge region, the energy of the laser radiation 14 necessary to generate photodisruption does not have to increase or increase as strongly as in the case of using the patient adapter 28 b according to FIG. 4 b , but can remain almost constant.

Patient adapter 28d in FIG. 4d differs from patient adapter 28c in FIG. 4c simply by virtue of the use of plano-concave contact lenses 30d rather than concave-convex contact lenses 30c. In the case of this plano-concave contact lens 30d, the contact surface 32d facing the eye 16 is concavely shaped, while the surface 33d facing away from the eye is planar. Instead of using plano-concave contact lenses 30d, biconcave contact lenses can also be used, in which both the abutment surface facing the eye 16 and the surface facing away from the eye 16 are concavely shaped. Contact lens 32 may include freeform surfaces on one or both of face 32d and face 33d. It can be seen from FIG. 4d that the patient adapter 28d also produces an at least almost constant focal diameter in the transverse and axial directions.

The patient adapter 28e shown in FIG. 4e comprises a planar contact lens 30e in which an abutment face 32e (face 32e facing the eye) and a face 33e positioned opposite the abutment face (face 33e facing away from the eye) Flat form takes shape. In addition, in the patient adapter 28e, an optical auxiliary element 35 is formed. The optical auxiliary element comprises: a concave surface 35b facing the eye and a flat surface 35b facing away from the eye. One or both of the surface 35a and the surface 35b may be shaped in the form of a free-form surface. It can be seen from FIG. 4e that this optical auxiliary element brings about a reduction of the focal diameter in the peripheral region. In the central region, an enlargement of the focal diameter and thus an adaptation of the focal diameter in all positions in the lens 16 b can be brought about. In the central region, the focal diameter can also be kept constant.

4f shows a patient adapter 28f comprising a meniscus contact lens 30f, wherein an abutment face 32f (eye-facing face 32f) is concavely shaped, and a face 33f (eye-facing face 33f) positioned opposite the abutment face Convexly shaped. The contact lens 30f may also include an optical freeform surface on one or both of the face 32f and the face 33f. It can be seen from Fig. 4f that the patient adapter 28f will also produce an at least nearly constant focal diameter in the transverse and axial directions. Patient adapter 28f of Figure 4f corresponds to patient adapter 28x of Figure 2d.

Irrespective of the element on which the one or more freeform surfaces are formed (optical assist element 35, contact lens 30c, contact lens 30d), said at least one freeform surface may be matched to an average human eye or may be patient individual form. Thus, the patient adapter may comprise one or more freeform surfaces that bring about the required adaptation of the focal diameter in the average human eye. However, it is conceivable to examine the human eye before machining it and to derive patient-individual data therefrom. From the patient-individual (eye-specific) data, it is possible to calculate the free-form surface which is then formed in the associated patient-individual patient adapter. Therefore, the precision of machining can be improved. Likewise, it is conceivable to add front wave correction for increased machining precision by using an adaptation system in the form of mirror 42 in an exemplary manner.

Furthermore, each freeform surface can be provided with an optical coating in order to reduce reflection losses of the laser radiation 14 .

As described in conjunction with the figures, with the aid of different patient adapters 28a to 28e, different machining operations can be carried out in the laser device 10 of the same height, even if the settings of the laser device remain unchanged. Thus, a system for obtaining different types of treatments can be realized with the same laser device.

In general, specific values commonly used for therapeutic purposes of specific areas of the eye are given in tables considered exemplary, which should not be construed as limiting).

Claims (12)

1. A laser system for eye surgery comprising: An eye surgical laser device having: an optical assembly for providing pulsed focused laser radiation having radiation properties matched to the generation of photodisruption in human eye tissue; and a control unit for positional control of the radiation focus of said laser radiation, said control unit being designed to execute a plurality of control programs representing various types of incision shapes; and A set of interface devices, each interface device comprising: a contact body transparent to said laser radiation, said contact body having an abutment surface for abutting against an eye to be treated; and a coupling portion for detachably coupling said interface device to a counter-coupling part of said laser device; each interface device of said set of interface devices differs due to a different optical effect on said laser radiation provided in said laser device , wherein, depending on the coupled set of interface devices, different spot diameters of radiation focusing are obtained. 2. The system of claim 1 , wherein at least a subset of the interface devices differ due to different effects on the location of the radiation focus relative to the abutment surface; and/or wherein at least a subset of said interface devices differ due to a different shape and/or position of at least one optical boundary surface; and/or wherein at least one subset of said interface devices differs due to a different number of optical elements; and/or Therein, at least one of the interface devices comprises an applanation cone designed for coupling to the eye and to the focusing optics of the laser device. 3. The system according to claim 1 or 2, wherein the laser device further comprises an adaptive optical element arranged on the laser device along the direction of propagation of the laser radiation. Upstream of focusing optics. 4. The system of claim 3, wherein the adaptive optical element comprises an adaptive mirror or a light transmission adaptive system. 5. The system according to claim 1, wherein at least one of the interface devices includes a code/code, the laser device is configured to recognize the code/code and invoke the associated control program. 6. A set of interface devices for use in laser devices for eye surgery, each said interface device comprising: a contact body transparent to the laser radiation of said laser device, said contact body having a the abutment surface of the eye; and a coupling portion for detachably coupling the interface device to the coupling portion of the laser device; said interface device differs due to a different influence on the radiation focus of said laser radiation relative to the position of said abutment surface, and/or said interface device differs due to a different shape and/or position of at least one optical boundary surface, and/or said interface devices are different due to different numbers of optical elements; Wherein, according to the set of interface devices, different spot diameters of radiation focusing can be obtained. 7. A set of interface devices according to claim 6, wherein at least one of said interface devices comprises a planar contact lens having a planar abutment surface for abutting against the eye, with said The oppositely located face of the abutment face is arranged planarly parallel to said abutment face. 8. A set of interface devices according to claim 7, wherein at least one of said interface devices comprises an optical auxiliary element. 9. A set of interface devices according to claim 8, wherein the optical auxiliary element is arranged in the interface device in such a way that the face facing away from the contact lens is shaped convex or planar Form, the face facing the contact lens is concavely shaped. 10. A set of interface devices according to claim 9, wherein the face facing the contact lens and/or the face facing away from the contact lens is formed as a free-form surface. 11. The set of interface devices of claim 6, wherein at least one of said interface devices comprises a biconcave contact lens having a concave abutment surface for abutment against an eye, and the face located opposite the abutment face is concavely shaped; and/or Wherein, at least one of the interface devices comprises a concave-convex contact lens or a plano-concave contact lens, the concave-convex contact lens or the plano-concave contact lens has a concave abutment surface for abutting against the eye, and The oppositely positioned face is shaped in a convex or planar form. 12. A set of interface devices according to claim 11, wherein the abutment surface and/or a surface located opposite to the abutment surface is formed as a free-form surface.